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Sunday, 12 November

• Who: SpaceX
• What: Falcon 9 B5
• When: 9:08 - 10:37 p.m. UTC
• Where: Cape Canaveral, Florida, US
• Why: SpaceX will be launching two O3b mPOWER broadband satellites into a medium Earth orbit for the satellite telecommunications provider SES. The Boeing-made satellites were supposed to be launched this week on November 9 but faced a delay. These satellites have an electric propulsion system that will allow the satellites to operate in a medium Earth orbit for at least a decade.

Thursday, 16 November

• Who: SpaceX
• What: Falcon 9 B5
• When: 3:00 a.m. UTC
• Where: Cape Canaveral, Florida, US
• Why: SpaceX will launch 23 Starlink mini satellites into a low Earth orbit where they will provide internet for customers back on Earth. This group of satellites is designated Starlink Group 6-28 - it’s possible to find these satellites on tracking software like ISS Detector if you want to try your luck at viewing them as they pass over your house.

Recap

• The first launch this week was a SpaceX Falcon 9 carrying 23 Starlink satellites. This is Starlink Group 6-27. The first stage of the rocket landed back on the “Just Read the Instructions” drone ship in the Atlantic Ocean. By reusing the first states of rockets, SpaceX can save a lot of money.

• The second and final launch of the week was another Falcon 9 but this time carrying the CRS-29 Dragon spacecraft on a cargo mission to the space station. This spacecraft was carrying various science experiments.

That’s all for this week, check back next time

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I saw this post on Reddit: Would a cockroach survive a fall from the stratosphere? Oh, what a lovely question. But why stop there? The stratosphere only goes up 50 kilometers—what about a cockroach falling from outer space? Space starts at the Kármán line, which is 100 kilometers up (or about 62 miles.)

Let's figure out an approximate answer.

Falling Without Air

Like most real-world problems, physics can get very complicated. When a physicist considers the fate of this falling cockroach, their first step is to change the problem into something simpler. It's not cheating—it's just getting a starting answer to think about.

Obviously the biggest complicating factor is going to be the interaction between the cockroach and the air. The air will exert a significant backwards-pushing force that changes with the velocity of the roach. So, what if we imagine it is falling in an environment without air? That's much simpler.

The way the air interacts with a falling object depends on the object’s shape, but since we don’t have any air in this first calculation, the shape doesn’t matter. So let’s simplify again and imagine that the cockroach is a sphere. Specifically, let’s suppose we have a spherical object with a mass (m) dropped from a height (h) above the ground. How fast will it be traveling when it impacts the Earth?

If we had dropped this round roach from a tall building, we could assume the gravitational force to be constant and calculated as the mass multiplied by the gravitational field (g), which equals 9.8 newtons per kilogram. However, as we get farther from the Earth’s surface, we can no longer assume that the gravitational field is constant.

We can calculate the value of g with the following expression. Here, G is the universal gravitational constant, M_E is the mass of the Earth, R_E is the radius of the Earth, and h is the height above the surface.

Illustration: Rhett Allain

Since the radius of the Earth is quite large (6.38 x 10⁶ meters), it will dominate the value of the denominator in that expression. Even using an h of 10,000 meters, the gravitational field will only drop to a value of 9.76 N/kg. You could say it's essentially constant. Of course, if you move up to 100 km, then the field will decrease to a value of 9.49 N/kg. This means we need a way to take into account this changing force for a falling object.

There are two ways we could do this. First, we could use the work-energy principle to find the value of the final velocity using the change in gravitational potential. However, this method won't work when we add the air back into the problem, since the force from the air can’t be represented as an energy. So maybe this isn't the best option.

The second method breaks the motion of the falling object into very short time intervals. Let's say they are each one second long. During each of these intervals, we can approximate the gravitational field with a constant value. That means we can use some simple physics to find the change in velocity and position during this one-second interval.

In order to model the motion over 100 seconds, we would need 100 of these calculations. No one has time for that many calculations—the simple solution is to make a computer do all the hard work. I like to use Python to create these numerical calculations, but you can use whatever code makes you happy. Here’s the code if you want to see my version of this falling object motion.

With that, we can get the following plot showing the speed of the object as it falls:

Illustration: Rhett Allain

This shows that upon impact, the object would be traveling at 1,389 meters per second, which is 3,107 miles per hour. This is greater than Mach 4, and faster than the fastest jet plane. But it’s not very realistic—air resistance will prevent a dropped object from moving that fast. Yes, we’re finally going to have to consider the effects of air.

Falling With Air

We can model the interaction between a moving object and the air with a drag force. You already intuitively understand drag force: It’s what you feel when you put your hand out of the window of a moving car and the air pushes back on your hand. This air drag increases in magnitude as the car goes faster.

Let's approximate the magnitude of this force with the following equation:

Illustration: Rhett Allain

In this expression, ρ is the density of the air, A is the cross-sectional area of the object (for a sphere this would be the area of a circle), C is a drag coefficient that depends on the shape of the object, and v is the magnitude of the velocity. Since this air resistance force depends on the speed, and the speed depends on the force (because of Newton's second law), this would be a challenging problem to solve. However, since we are breaking the motion into short time intervals, we will assume the drag force is constant for that short time. This makes it much easier to solve.

But wait! It's not just the velocity of the object that changes. The density of air also changes with altitude. Near the surface of the Earth, the density of air is around 1.2 kilograms per cubic meter, but it just keeps decreasing as you get higher. (Yes, there's even some air in low Earth orbit.) Fortunately, we have a model for the density of air as a function of altitude. It's sort of complicated—but who cares? As long as we can calculate this value, we can plug it into the air drag formula and use it in the numerical calculation.

There's one more thing to consider. If there's no air drag on a falling object, then the total force is only the gravitational force and this is proportional to the mass. Remember, Newton's second law says the net force is equal to the product of the mass and the acceleration (F_net = ma). With the net force being proportional to the mass, we can cancel that with the mass multiplied by the acceleration, such that the acceleration doesn't depend on mass. This is why in some cases objects of different mass will hit the ground at the same time.

However, if we add air drag, the net force depends not just on the mass but also on the size of the object. This means that a falling bowling ball and a falling tennis ball will have different motions.

OK, let's get to the plot. Here is the same plot for four drops: an object with no air resistance, and three that have air resistance—a cockroach, a tennis ball, and a bowling ball. I randomly picked the bowling and tennis balls just to see how different-sized spherical objects would fall. I mean, if you can imagine a situation where a bug drops from space, then why not a bowling ball?

(Check out the full code here.)

Illustration: Rhett Allain

There's some cool stuff going on here. Notice that for the objects with air resistance, they all reach incredibly high velocities as they fall in the upper atmosphere where they encounter very little air resistance. However, once they get into the thicker air they slow down. The cockroach slows in a weird way because my air density model (for very high altitudes) has low resolution.

But all of those objects eventually reach some terminal velocity. For the bowling ball, this final velocity is 83 meters per second (185 mph), whereas the cockroach ends up with a speed of only 1.5 meters per second (3.3 mph). The tennis ball comes in between these two, with a terminal velocity of 23.8 m/s (53 mph). If you want to try a different object, use the link to the code and put in the values of the object you wish to drop.

From a survivability standpoint, it looks like the cockroach might make it. If you have ever seen a cockroach, you know that they can easily move faster than you can walk, which is about 3 mph. If they can move that fast on the floor, I feel like they would survive an impact with the ground at this same speed.

The tennis ball should also be fine—that terminal velocity is something you could see during a tennis match. However, that bowling ball is probably going to be destroyed. I'm sure if it collides with a hard surface, like cement or dry dirt, it's just going to explode. It might survive impact with something softer, like water or mud.

Falling and Heating

If you have paid attention to anything related to space exploration, you know that when objects reenter the atmosphere with very high velocities, they get hot. The interaction between the object and the air creates a backwards-pushing air resistance force, but it also compresses the air in front of the moving vehicle. This compressed air gets hot and in turn heats up the forward surface of the falling object. For a spacecraft during reentry, this heating can be quite extreme—so extreme that it needs a heat shield to prevent the rest of the vehicle from melting.

So, what about our falling objects? Things can get pretty complicated when dealing with moving air, especially at high speeds, but that's fine. Since this is just for fun and not for actual aerospace applications, we can use a rough approximation to calculate the amount of heating during the fall.

First, we can calculate the work done by the air resistance force. Work is basically a product of the force (which I have already calculated) and a distance. Since the force changes as the object falls, I can calculate the tiny amount of work during each tiny time interval in my program above, and then just add up all these small bits of work to find the total.

Second, I'm going to assume that this work goes into heating both the air and the object—just to make it simple, I can say half of the energy goes to the object.

Finally, I can estimate the specific heat capacity for each object. This is a property that gives a relationship between the energy going into the object and the change in temperature. Note: I'm absolutely not going to experimentally measure the specific heat capacity of a cockroach.

With those estimations, I get some wild numbers. The bowling ball has a temperature change of over 1,000 degree Celsius. That's around 2,000 Fahrenheit, which is super hot. The tennis ball is even worse. The calculations show that it would increase by 1,700 C, or 3,000 F. If either of these balls reached those temperatures, they would not only melt but vaporize. There would be nothing left to hit the ground.

What about the cockroach? It also seems to not fare so well, obtaining a change in temperature of 960 C.

If these temperatures seem extreme, maybe they are. This assumes that the object increases in temperature during every time interval. It does not take into account the cooling effect of moving through other air.

Let's instead look at how fast the objects increase in temperature just due to interaction with the air. Here's a plot of the rate of temperature change for the three objects:

Illustration: Rhett Allain

The bowling ball was out of control. I scaled down the data by a factor of 0.001 so that you could still see the detail in the temperature rates for the tennis ball and the cockroach.

The results are bad news, at least for those of us who aren’t too fond of cockroaches. Notice that the cockroach has short periods of increase in temperature. (This is probably due to the transition to higher-density air where it has to slow down.) But during the rest of the fall, it's not heating up much. This would give it plenty of time to cool off, increasing its odds of survival.

The same is true for the tennis ball, even though it does have periods with much higher rates of temperature change.

The bowling ball, on the other hand, has a period of rapid heating at around 10,000 C per second. With its larger mass, it can really pick up some serious speed before essentially colliding with the much denser air near the ground. This causes a huge spike in air resistance and rapid temperature changes. I think the bowling ball might actually melt if dropped from space. Too bad that cockroach isn't a bowling ball.

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The bureau estimates the global population exceeded the threshold Sept. 26, a precise date the agency said to take with a grain of salt.

The United Nations estimated the number was passed 10 months earlier, having declared November 22, 2022, the “Day of 8 Billion,” the Census Bureau pointed out in a statement.

The discrepancy is due to countries counting people differently — or not at all. Many lack systems to record births and deaths. Some of the most populous countries, such as India and Nigeria, haven’t conducted censuses in over a decade, according to the bureau.

While world population growth remains brisk, growing from 6 billion to 8 billion since the turn of the millennium, the rate has slowed since doubling between 1960 and 2000.

People living to older ages account for much of the recent increase. The global median age, now 32, has been rising in a trend expected to continue toward 39 in 2060.

Countries such as Canada have been aging with declining older-age mortality, while countries such as Nigeria have seen dramatic declines in deaths of children under 5.

Fertility rates, or the rate of births per woman of childbearing age, are meanwhile declining, falling below replacement level in much of the world and contributing to a more than 50-year trend, on average, of slimmer increases in population growth.

The minimum number of such births necessary to replace both the father and mother for neutral world population is 2.1, demographers say. Almost three-quarters of people now live in countries with fertility rates around or below that level.

Countries with fertility rates around replacement level include India, Tunisia and Argentina.

About 15% of people live in places with fertility rates below replacement level. Countries with low fertility rates include Brazil, Mexico, the U.S. and Sweden, while those with very low fertility rates include China, South Korea and Spain.

Israel, Ethiopia and Papua New Guinea rank among countries with higher-than-replacement fertility rates of up to 5. Such countries have almost one-quarter of the world’s population.

Only about 4% of the world’s population lives in countries with fertility rates above 5. All are in Africa.

Global fertility rates are projected to decline at least through 2060, with no country projected to have a rate higher than 4 by then, according to the bureau.

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Artist rendition of the NuScale Power nuclear power plant.

The plan for the first small-scale US nuclear reactor was exciting, ambitious, and unusual from the get-go. In 2015, a group of city- and county-run utilities across the Mountain West region announced that they were betting on a new frontier of nuclear technology: a mini version of a conventional plant called a “small modular reactor” (SMR).

Advocates said the design, just 9 feet in diameter and 65 feet tall, was poised to resurrect the US nuclear industry, which has delivered only two completed reactors this century. It was supposed to prove out a dream that smaller, modular designs can make splitting atoms to boil water and push turbines with steam much cheaper. But first that reactor, the Voygr model designed by a startup called NuScale, had to be built. A six-reactor, 462-megawatt plant was slated to begin construction by 2026 and produce power by the end of the decade.

On Wednesday, NuScale and its backers pulled the plug on the multibillion-dollar Idaho Falls plant. They said they no longer believed the first-of-its-kind plant, known as the Carbon Free Power Project (CFPP) would be able to recruit enough additional customers to buy its power.

Many of the small utilities underwriting the pioneering project, members of a group called the Utah Associated Municipal Power Systems (UAMPS) saw the pint-sized nuclear plant as a potential solution to pressure to reduce their carbon emissions. The Department of Energy, which was due to host the plant at Idaho National Lab, awarded $1.4 billion to the project over 10 years.

But as WIRED reported in February, the utilities backing the plant were spooked late last year by a 50 percent increase in the projected costs for the project—even after factoring in substantial funds from the Inflation Reduction Act. The Idaho Falls reactors’ chances of survival began to look slimmer.

At the time, commitments in place to buy the reactor’s future power covered less than 25 percent of its output. UAMPS set itself a year-end deadline to bump that figure to 80 percent by recruiting new customers. Reaching that number was seen as key to ensuring the project’s long-term viability. As the project moved into site-specific planning and construction, its costs were poised to become more difficult to recoup if the plant ultimately failed, heightening the risks for the members.

Atomic Homecoming

As recently as last month, local officials returned to their communities from a UAMPS retreat with a reassuring message that the Idaho Falls project was on track to secure the new backers it needed, according to local meetings reviewed by WIRED.

That appeared to be good news in places like Los Alamos, New Mexico, where an official this spring described the project as a “homecoming” for atomic technology. The project was due to arrive just in time to help the county meet its goal of decarbonizing its electrical grid and adjusting to the retirement of aging fossil fuel plants nearby. At the time, locals expressed concern about where they would find clean and consistent power if the first-of-its-kind plant was to go away, given limited capacity to connect to new wind and solar projects in the region.

Now that the project is dead, SMR skeptics say the municipalities should find those cleaner power sources and focus on proven technologies. “One of the stories they’ve kept telling people was that the SMR was going to be a lot cheaper than large-scale nuclear,” David Schlissel, an analyst at the nonprofit Institute for Energy Economics and Fiscal Analysis, told WIRED last month. “It isn’t true.”

UAMPS spokesperson Jessica Stewart told WIRED that the utility group would expand its investments in a major wind farm project and pursue other contracts for geothermal, solar, battery, and natural gas projects.

Successful Failure?

On a quarterly call with investors Wednesday, NuScale CEO John Hopkins claimed the project as a “tremendous success” for the company, saying that the advances made with federal regulators for its Voygr design mattered more than the fate of an individual plant.

NuScale remains somewhat ahead of competitors working on smaller nuclear plants. In 2022, it was the first to receive design approval from the US Nuclear Regulatory Commission, although an updated design planned for its initial projects still requires approval. On the investor call, other NuScale executives touted the company’s plans to build reactors in Romania and to power data centers in Pennsylvania and Ohio built by Standard Power, a cryptocurrency mining company. NuScale says it still plans to have plants operational by the mid-2030s.

The company’s remaining projects were questioned last month in a report issued by short-seller Iceberg Research. The group expressed doubts about Standard Power’s ability to spend hundreds of millions of dollars on NuScale’s technology, noting the sparse details provided about the cryptocurrency firm and its financial backers. On Wednesday’s call, NuScale defended the project, saying it hoped to provide more details soon. “We know that the sites they’re developing are real sites,” said Robert Ramsey Hamady, NuScale’s chief financial officer, who joined the company in August.

In a statement provided through NuScale spokesperson Garrett Poorman, Standard Power denied the allegations in the report and said it had access to adequate capital. NuScale also published its own response. The company says it remains focused on doing what it set out to do: building a new type of reactor and proving it can provide carbon-free, around-the-clock power at a more reasonable cost than its mammoth ancestors, which are still a linchpin of the grid today.

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A study by the British Heart Foundation (BHF) represents the first of its kind to examine the link between daily movement patterns and cardiovascular health. This represents the first findings to surface from the global Prospective Physical Activity, Sitting, and Sleep (ProPASS) consortium.

“The big takeaway from our research is that while small changes to how you move can have a positive effect on heart health, intensity of movement matters,” says Dr. Jo Blodgett, first author of the study from UCL Surgery & Interventional Science and the Institute of Sport, Exercise & Health, in a media release. “The most beneficial change we observed was replacing sitting with moderate to vigorous activity – which could be a run, a brisk walk, or stair climbing – basically any activity that raises your heart rate and makes you breathe faster, even for a minute or two.”

The study discovered that the greatest benefits to heart health came from time spent in moderate to vigorous activity, followed by lighter activity, standing, and then sleeping. Just five minutes of higher-intensity activity had a noticeable positive impact on heart health.

Simple modifications, such as opting for a standing desk over sitting, could contribute to heart health over the long term.

Standing desk (Photo by TheStandingDesk on Unsplash)

“Though it may come as no surprise that becoming more active is beneficial for heart health, what’s new in this study is considering a range of behaviors across the whole 24-hour day,” adds the joint senior author of the study, Professor Mark Hamer. “This approach will allow us to ultimately provide personalized recommendations to get people more active in ways that are appropriate for them.”

Heart health is critical as cardiovascular disease remains the leading cause of death worldwide, accounting for one in three deaths in 2021. The prevalence of cardiovascular disease has doubled since 1997.

“We already know that exercise can have real benefits for your cardiovascular health and this encouraging research shows that small adjustments to your daily routine could lower your chances of having a heart attack or stroke,” says BHF Associate Medical Director Professor James Leiper. “This study shows that replacing even a few minutes of sitting with a few minutes of moderate activity can improve your BMI, cholesterol, waist size, and have many more physical benefits.”

The researchers emphasize the importance of sustainable, enjoyable changes to one’s routine to promote lasting active habits. Suggestions include “activity snacks,” such as walking during phone calls or doing star jumps regularly throughout the day.

Just replacing half an hour of daily sedentary behavior with moderate to vigorous exercise can lead to significant physical changes like a one-inch reduction in waist size.

The findings come from six studies that evaluated 15,246 participants across five countries, employing wearable technology to track six health indicators.

“A key novelty of the ProPASS consortium is the use of wearable devices that better differentiate between types of physical activity and posture, allowing us to estimate the health effects of even subtle variations with greater precision,” adds Professor Emmanuel Stamatakis, a joint senior author of the study from the Charles Perkins Centre and Faculty of Medicine and Health at the University of Sydney.

The study is published in the European Heart Journal.

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Medical science has made a major breakthrough in the fight against lung cancer, according to a report by Fox News Digital. Citing research published in The New England Journal of Medicine, the report highlights that the medication Osimertinib, sold under the brand name Tagrisso, is effective in reducing the five-year risk of recurrent cancer by up to 73% and the risk of death by up to 51%.

In an interaction with Fox News Digital, Dr. Faiz Y. Bhora, chief of thoracic surgery and central region chair of surgery at Hackensack Meridian Health in New Jersey talked about the effectiveness of the medication and said, "In the world of oncology, that is earth-shattering."

"In the past, medical oncologists were happy with 5% or 10% — and now we're talking about in excess of 50% improvement in survival," added Dr. Bhora.

Interestingly, Dr. Bhora highlighted that he has recommended the medication to several lung cancer patients and it has yielded positive results for them.

"We're truly in the era of personalized medicine. We now have a lot of targeted therapies that work well for patients who have mutations in their tumors," said Dr. Bhora.

According to the report, the medication Tagrisso is effective for patients who have a genetic mutation called EGFRm and who have already had surgery.

"The pill helps prevent recurrence once the tumor is removed with surgery for those with the genetic marker," said Dr. Bhora.

Talking about lung cancer, the doctor highlighted that it's not just smokers who are at risk of contracting the disease.

"We used to think of lung cancer as just a smoker's illness. Now, we know that over 30% of individuals who develop lung cancer have never smoked, and a lot of them are women," highlighted the doctor.

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Health organizations are warning of an imminent public health crisis in the Gaza Strip, where disruptions to health and water systems are raising the risk of disease outbreaks.

The International Rescue Committee (IRC) on Thursday warned of the inevitable spread of waterborne illnesses such as cholera and typhoid, caused by contaminated water sources and a lack of sanitation.

Currently, 95 percent of the population in Gaza has no access to safe water, while 64 percent of primary health facilities have shut down, IRC warns, as Israel conducts a lethal bombing campaign.

“The conditions are ripe for the spread of communicable and waterborne diseases — diseases that adversely affect children and lead to preventable deaths,” said Bob Kitchen, the IRC's vice president of emergencies.

The World Health Organization (WHO) on Wednesday warned that lack of fuel has disrupted waste collection and caused desalination plants to shut down, leading to a significant increase in the spread of bacterial infections, such as diarrhea, which has already hit 33,551 people since mid-October.

The organization said that with almost 1.5 million displaced people across Gaza, health facilities and shelters are overcrowded, raising the risk of infectious disease transmission.

"Disrupted routine vaccination activities, as well as lack of medicines for treating communicable diseases, further increase the risk of accelerated disease spread," the WHO warned.

Both the WHO and IRC have reiterated their call for a humanitarian cease-fire to allow aid into the strip, which Israel has been striking for more than a month in retaliation for Hamas militants' deadly attack against Israel on October 7.

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Italian researchers looked at post-COVID outcomes for 88 people who lost their sense of taste and smell early in in the pandemic, with everyone contracting "mild" COVID-19 during March and April of 2020. Patients averaged 49 years of age at the study's start.

Mild COVID-19 was defined as an illness without any evidence of lower respiratory disease.

Compared to 88 people who had never tested positive for COVID-19, rates of loss of smell and/or taste (as measured by standard tests) were roughly equal three years later, said a team led by Dr. Paolo Boscolo-Rizzo of the University of Trieste in Italy.

"At the 3-year study end point, olfactory dysfunction was comparable between both groups," the group reported Nov. 9 in the journal JAMA Otolaryngology-Head and Neck Surgery.

As for a loss of the sense of taste ("gustatory dysfunction"), Boscolo-Rizzo's group similarly found "no significant differences" between folks who'd had mild COVID-19 and the never-COVID-19 groups, two and three years later.

The findings should be welcome news because, until now, "no data exist regarding psychophysical assessment of olfactory dysfunction and gustatory dysfunction after COVID-19, to our knowledge," the team said.

While many patients who went through a bout of COVID-19 did complain of deadened senses of taste and smell, the new study finds that sense recovery does happen over time.

For example, while about two-thirds (64.8%) of people with mild COVID-19 said they'd lost their sense of smell and/or taste at the time they were ill, that number dropped to about 32% one year later, then to 20.5% two years after infection, and finally to about 16% three years later.

That last number differed only slightly from the group of people who had never tested positive for COVID-19, the researchers noted.

The bottom line, according to the researchers: Former COVID-19 patients "should be reassured that a recovery of olfaction appears to continue over 3 years after initial infection."

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On November 8, the United States Food and Drug Administration (FDA) approved a Type 2 diabetes drug called tirzepatide for use in chronic weight management. It has been sold under the brand name Mounjaro for treating diabetes, but it will be called Zepbound when prescribed for weight loss.

The drug is made by pharmaceutical company Eli Lilly and doses should be available after Thanksgiving.

How Zepbound works

The medicine is a weekly injectable medication and the main ingredient is called tirzepatide. It mimics two hormones called glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). Both are naturally produced in the body and the drug targets receptors in the brain for these hormones.

Both GIP and GLP-1 bind to receptors in the brain that tell the body it is full. GLP-1 also slows digestion to make people feel fuller longer and with smaller portions. American Board of Obesity Medicine medical director Kimberly Gudzune told The Washington Post that GLP-1 targets the receptors in the brain that decrease appetite and it slows digestion to make people feel fuller longer and with smaller portions. Additionally, GLP-1 increases the amount of insulin that the pancreas releases after eating, which slows down the rise in blood sugar.

GIP meanwhile works in the brain to decrease appetite and may also improve how the body breaks down fats and sugars.

Who is eligible for Zepbound?

The FDA cleared Zepbound for adults 18 and older considered obese (a body mass index of at least) or overweight (a body mass index of 27 or more) with at least one weight-related health condition. The FDA also said that it should be taken with exercise and a reduced-calorie diet.

What is a ‘weight-related condition’?

Weight-related conditions are medical complications that can arise from being overweight or obese. According to the Centers for Disease Control and Prevention (CDC), they include high blood pressure (hypertension), high LDL cholesterol, high levels of triglycerides, and Type 2 diabetes. 

Roughly 70 percent of American adults are considered overweight or obese by body mass index, according to the FDA. However, body mass index (BMI) is an imperfect metric for measuring health that has been questioned by the American Medical Association. Losing five to 10 percent of body weight with diet and exercise has been associated with a reduced risk of cardiovascular disease in adults who are overweight or obese

“Obesity and overweight are serious conditions that can be associated with some of the leading causes of death such as heart disease, stroke and diabetes,” director of the FDA’s Division of Diabetes, Lipid Disorders, and Obesity John Sharretts, said in a statement. “In light of increasing rates of both obesity and overweight in the United States, today’s approval addresses an unmet medical need.”

How effective is Zepbound?

The FDA’s approval comes on the heels of a phase 3 clinical trial. All of the participants in the study had obesity or were overweight and had at least one weight-related condition.

At the highest dosage of tirzepatide (15 milligrams) participants saw an average weight loss 22.5 percent body weight, or about 52 pounds, over a period of 72 weeks. At a 10 mg dose, the average weight loss was about 21.4 percent (48 pounds). At only five milligrams, average weight loss was about 16 percent (35 pounds).

How does it compare to Ozempic or Wegovy?

Ozempic and Wegovy contain an ingredient called semaglutide. It works by suppressing the appetite by mimicking GLP-1, a hormone that signals to the brain that the stomach is full. In similar clinical trials, semaglutide has been shown to reduce body weight by roughly 15 percent (34 pounds) after 68 weeks.

By comparison, the tirzepatide in Mounjaro and Zepbound works on both the GLP-1 and GIP pathways.

While those taking tirzepatide lost more weight than those taking semaglutide in separate trials, the data is not comparable due to potential differences in study length and population. More data is needed that compares both drugs at the higher doses needed for weight-loss, so it is too early to say if one is more effective than the other.

What are the potential side-effects?

In studies, the main side effects were gastrointestinal issues like nausea, vomiting, constipation, and diarrhea. The FDA says that Zepbound’s label will contain warnings for inflammation of the pancreas, gallbladder problems, low blood sugar, acute kidney injury, diabetic retinopathy, and suicidal behavior or thinking.

How much will Zepbound cost?

A one month supply of Zepbound is estimated to cost about $1,060. While it is less than Wegovy’s $1,300 price tag, both drugs may be too expensive for many that are eligible. Ozempic costs $936 per month before insurance.

Many insurance companies do not cover weight loss medication that is intended to treat Type 2 diabetes, but that could change with the FDA’s approval. Medicare and Medicaid are currently barred by law from covering weight loss medications. 

According to Eli Lilly, patients can sign up on its website for a copay, or a discount card program. The company also said that those who can get Zepbound through commercial insurance may pay as little as $25 for a one-month or three-month supply. It is unclear what will happen after that period as far as coast and weight staying off. Those who are commercially insured, but don’t have coverage for Zepbound, might be eligible to pay as little as $550 for a one-month prescription.

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The groundbreaking surgery involved removing part of the face and the whole left eye of a donor and grafting them onto a line worker from Arkansas who survived a 7,200-volt electric shock in June 2021, when his face touched a live wire.

Aaron James, 46, suffered extensive injuries including the loss of his left eye, his dominant left arm above the elbow, his nose and lips, front teeth, left cheek area and chin.

He was referred to NYU Langone Health, a leading medical center for facial transplants, which carried out the procedure on May 27.

Transplanting an entire eye has long been a holy grail of medical science, and though researchers have had some success in mice -- where they have restored partial vision -- it's never before been performed in a living person.

"We always talk about a second chance at life -- he's been given a second chance," said Eduardo Rodriguez, who led the 21-hour-surgery that made use of 3D cutting guides, which allowed surgeons to remove segments of bone from the donor and place them precisely in James.

"We couldn't have asked for a more perfect patient," he added, praising James for undergoing the extremely risky surgery so that others in his situation could benefit in the future.

The transplanted left eye appears very healthy, said retinal opthamologist Vaidehi Dedania. It has a good blood supply, is maintaining its pressure, and is generating an electrical signal, though James is not yet able to see. "But we have a lot of hope," she added.

- 'Huge deal' -

"This is a huge deal," Kia Washington, a professor of surgery at University of Colorado Anschutz Medical Campus, who has been working in the same field for 15 years, told AFP, commending her peers.

Daniel Pelaez of the University of Miami's Bascom Palmer Eye Institute, who has also been working towards the same goal, told AFP:  "The transplantation of a human eye at NYU Langone represents a pivotal moment in our common quest to restore sight and offers hope to countless individuals around the world."

James, whose right eye remains intact, was considered an ideal candidate because his need for a facial transplant meant he would require immunosuppressive drugs regardless, making the risk-benefit calculation favorable -- even if it conferred only cosmetic value.

Appearing at a press conference, James expressed his profound gratitude to both the donor's family and his medical team. "It's been a test of willpower, strength, family, friends, and I think we beat it," he said.

James returned to his native Arkansas in September to be with his wife and daughter but returns to New York for monthly follow-up appointments.

Optic nerve regeneration

Given the time that has passed since the surgery, Washington said she did not think it likely that James's eye would regain vision, but "I never say something is impossible," she added.

The NYU Langone team said they had used bone marrow-derived adult stem cells to promote nerve repair.

Achieving the goal of sight restoration could involve bringing other cutting-edge approaches to bear, said Washington -- including gene therapy to tap the optic nerve's intrinsic ability to heal; using a device called a nerve wrap to protect the tissue; or using devices that pick up signals and bypass the damaged pathway.

"We're making great progress in the treatments to promote optic nerve regeneration that could accompany eye transplant," Jeffrey Goldberg, who is leading similar efforts at the Byers Eye Institute at Stanford University, told AFP.

"These adjunctive therapies will allow the donor eye to significantly connect to the brain and restore meaningful visual function to blind patients everywhere."  —  Agence France-Presse

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According to Day, this is achieved by looking at patterns and similarities between published papers and known paper mill-generated works. He claims that this is the best approach for detecting paper mill works, since these works are created in large batches and, generally, carry formatting, styling and other similarities between them.

Day used his software to analyze some 48 million papers published since 2000. He found that some 400,000 of those articles share “strong textual similarities” to known paper mill studies, and that includes some 70,000 in 2022 alone. All in all, the study estimates that between 1.5% and 2% of all papers published in 2022 came from essay mills.

Day also examined a smaller subset of 2.85 million works published in 2022 where information about the subject area was available. In that subset, he found 2.2% resembled paper mill studies, but found wide variances in subject, with medicine and biology coming in at over 3% while Economics was well below 0.5%.

However, others in the field have been quick to criticize this analysis. Day only shared the analysis Nature, and it has not been through peer review nor has it been published. Of particular concern was the potential for false positives, with legitimate research being caught in the net simply for using a similar template.

Day also has not shared details about how his tool works, citing the need to protect his intellectual property and prevent paper mills from learning how to circumvent it.

In June 2022, the Committee on Publication Ethics (COPE) and the International Association of Scientific, Technical, and Medical Publishers (STM) released a similar study about paper mill works and found the most journals could expect to see about 2% of the papers submitted to them be paper mill works, with those that published paper mill works see that number leapt to as high as 46%.

However, that study looked at papers submitted to journals, where the most recent one looks at publications. That’s why other experts in the field believe that Day’s estimates are reasonable but at the upper bounds of likelihood. Elizabeth Bik and David Bimler, both research integrity experts interviewed for the Nature article, both indicated that the numbers are, at the very least, possible, but felt the numbers were high.

Day himself, on the other hand, seems to think his study is likely an underestimation as his tool can only compare to known paper mill works. As such, he believes that the likelihood of false negatives is greater than false positives, especially since he claimed to have taken significant steps to eliminate the latter.

All this points to a significant problem: Finding out just how large of an issue paper mills are for scholarly publishing.

A Growing Concern

Back in March 2021, Bik, along with other researchers, published an article that identified some 1,400 published papers that were, at least potentially, linked to essay mills. However, even after notifying journals of the issue, only a small fraction of the papers were retracted.

While that was one of the first major alarms for the publishing industry, efforts to track the size and scope of paper mills go back to at least 2007, and likely far beyond that.

That, in turn, is something that’s pointed out by Day’s recent work. According to his unpublished estimates, he was able to find examples of likely essay mill publications going back to 2000, the earliest year in his data set.

However, according to data provided by Day, the problem has seen almost linear growth since 2000. Every year, there has been an increase in the percentage of papers published that have strong similarities with paper mill products.

Since it’s impossible and impractical to thoroughly investigate each individual work, it’s equally impossible to know how many false positives and negatives there are. As such, there’s likely no way to know, with any certainty, how big of a problem this is on the submission side or the publication side.

That said, there are three things we can say with relative certainty based on this and other research in this space:

1. “Researchers” Are Increasingly Turning to Paper Mills: The temptation to turn to paper mills is an ever-present one for those who are in positions where they need publications to either maintain their position or advance, but lack the time, funding and/or interest to do original research. The use of paper mills appears to be growing, along with the industry.
2. Legitimate Journals Are Being Impacted: The issue is often paired with predatory journals, which are journals that will publish virtually any paper, as long as they are paid a fee. However, paper mill papers are, increasingly, being submitted to legitimate journals who are being tasked with filtering out these papers. This has made tools like STM Integrity Hub crucial in the fight.
3. The Defenses Are Imperfect: No matter how many false positives and negatives there are in spotting these cases, it’s clear that the number of paper mill papers being published in legitimate, respected journals is not zero. That number is, ultimately, too high.

So that begs the question: What can be done about this problem?

Addressing the Problem

In the short term, journals need to strengthen both their review and peer review process in anticipation of receiving papers that were produced by paper mills. Tools like STM Integrity Hub and Papermill Alarm will likely be key components of any such strategy.

But regardless of what tools are used, checking to see if a paper is similar to paper mill works should be as much a part of the evaluation process as a plagiarism analysis, examination of the data and other steps that are part of the review process.

In the medium term, there needs to be a real conversation about if and how such services are allowed to operate.

Essay mills, which function similarly but are targeted at students rather than researchers, have long been under legal fire. They were outright made illegal in Australia, were cut off from payment processors and had their advertising targeted in the UK.

This strong response is largely owed to the fact that essay mills disproportionately targeted minors and young adults attending government institutions, namely high schools and colleges. Getting governments and other intermediaries to care that much about mills that target researchers submitting work to private publishers will be an uphill battle.

But while an outright ban may not be warranted or practical, broader efforts to dissuade and discourage the use of paper mills could yield results.

That said, as we discussed when looking at the issue of “Zombie Plagiarism”, change will be limited without systemic improvements. As long as there is a pressure to publish and a focus on quantity of publications over quality of publications, paper mills will likely continue to thrive, especially when paired with predatory journals.

Bottom Line

In a way, this seems like a strange problem to focus on right now. In November 2022, Open AI launched ChatGPT to the public and, with it, kicked off the generative AI land rush we’ve seen over the past year.

For essay mills and other cheating sites, this has been a complete disaster. There’s simply little reason for students to pay money for test answers and human-written essays when an AI can, most likely, generate what they need for free.

As such, in the classroom, the focus has shifted away from essay mills and contract cheating onto AI. Though essay mills and other contract cheating services certainly do exist, their influence is also clearly waning.

However, paper mills won’t be so quickly replaced in the research space. While AI will definitely have impacts here, paper mills provide more than just a paper. They often provide help finding a place to publish it and in securing the desired publication. We’ve seen this in the past with how paper mills have quickly pivoted where they submit papers to

Combine that with the complexities of the topics at hand and the (hopefully) thorough examination of peer review, AI will struggle to compete with humans in this space. That is, as long as authors hope to get published in legitimate and respected journals.

That’s not to say that AI-generated research papers aren’t or won’t be a problem. We’ve already had AI-generated abstracts fool scientists in studies. It just means that the human to AI ghostwriting transition will be slower in academic publishing than student essays.

That means that paper mills will remain relevant, even as the use of AI likely grows. That makes this a difficult one-two punch that journals are going to struggle to deal with.

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However, only those who lived near the city walls would have felt the utter horror of seeing human heads flung through the air: the inhabitants of nearby cities would not have received the news of these awful events until weeks or even months later. Even then, they would only have heard accounts of the events, without images or videos to reproduce exactly what happened. Eleventh century technology meant that weaponized mass terror had its limitations.

Throughout human history, nations—as well as political, religious and military groups—have used terror to gain tactical or strategic advantages. Inhabitants of the 21st century are more sophisticated but ultimately no better than their historical counterparts.

In today's world, omnipresent communication technology means the spread of horrific images is all but impossible to escape. We experience this now, for example, with images from Israel and Gaza, and other wars and attacks in recent years.

Images that release cortisol

Recently, research has been conducted into the psychological consequences of the phenomena known as "news information overload" and "generalized trauma event witnessing."

Even when viewed through a phone screen, experiencing an extremely violent situation activates the sympathetic branch of our nervous systems, which governs our "fight or flight" response. Our bodies react to these images by secreting hormones into the bloodstream including adrenaline, noradrenaline and cortisol, commonly known as the stress hormone. These hormones quickly cross the blood-brain barrier and penetrate our central nervous systems.

With these chemicals in our veins, our bodies change: heart rate and blood pressure increase to help us fight or flee the threatening stimulus and avoid injury or death. These are adaptive, short-term changes. If they become chronic, they can cause serious health problems in the long run, as has been common knowledge for decades.

So what does this constant exposure to threatening stimulus do to our brains? Is there a risk that it might affect our reasoning?

Poor memory and a loss of control

We have known for only a few years that, in both humans and animals, continued stress produces systemic changes in our brains. In acutely stressful situations the hippocampus' role in memory becomes inhibited, and the prefrontal cortex ceases to exercise control. At the same time, our nervous systems prioritize habits and routines through a region called the dorsal striatum, which is regulated by the amygdala, also known as the brain's fear center.

These changes are, in principle, intended to help us cope with specific stressful situations in the short term. When we face a threat the priority is to react quickly, not taking time to remember similar events and analyze contextual factors. But if this goes on for a long time, it can have serious consequences for our cognition in the medium and long term.

This is essentially because chronic stress causes problems for our learning and memory, affecting three areas which are worth exploring in more detail: precision, flexibility and reconsolidation.

1. Precision. The information that we process in stressful situations is more abstract and poorly contexualised. Attention is narrowed to focus only on the essential details of the stressful event.

2. Flexibility Stress practically eliminates our ability to integrate new information into existing frameworks. It also limits the way we can use these frameworks to appropriately process the stimuli that we are sensing. This makes it hard to transfer and apply previously acquired information to the immediate context. We might say that pressure and stress prevent us from making full use of experience.

3. Reconsolidation Our memories are usually not rigid, but rather they help us adapt to new conditions and learn about them. The process of updating and reestablishing our memories is known as "reconsolidation." Stress makes this process harder, and this in turn inhibits the reconstruction of memories that can help us to incorporate new information.

When these systemic changes to our psychological processes occur among a large part of society it can affect our ability to make rational political and social decisions, both among the population at large and among our leaders.

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Penicillins are the most prescribed class of antibiotics in Australia. Originally derived from a fungus, penicillin antibiotics such as amoxicillin are used to treat common infections, including chest, sinus, ear, urinary tract and skin infections.

Penicillins are effective against a wide range of bacteria that cause common infections. But their activity is not so broad as to impact on good bacteria in our gut like other antibiotic classes do. They're also cheap and readily accessible.

Up to 20% of Australians admitted in hospital say they have a penicillin allergy.

But not everyone who thinks they're allergic to penicillin actually is. Research from our team and others suggests that if we assess all these patients, up to 90% are not allergic to it.

Why does it matter?

People who mistakenly think they're allergic to penicillin may not get the most effective or safest antibiotics to treat their infection.

They are also at greater risk of developing multidrug-resistant infections or "superbugs." This is because the antibiotic will kill off the bacteria that are susceptible to it, but the resistant bacteria are left behind to proliferate and cause further infection.

People who receive second-line antibiotics are more likely to have complications, such as antibiotic-induced gut infections. Second-line antibiotics tend to have a wider range of activity, killing both the bacteria causing infection, and the good bacteria required to keep our gut in balance. This allows bugs like Clostridium difficile, which normally lives in our gut but is controlled by other bacteria, to overgrow and cause inflammation.

For the health system, using second-line antibiotics means longer, more complicated hospital stays. Hospital stays for patients with penicillin allergies cost up to 63% more more than those without. It also results in greater costs for medications and greater resources required to treat the patient.

Why do people think they're allergic?

People incorrectly believe they are allergic to penicillin for a number of reasons.

They may have experienced side effects from penicillin, such as nausea or diarrhea. But though unpleasant, this doesn't mean an allergy.

Others had a rash as a child, but this could have been due to the illness itself or an interaction between the virus and the antibiotic. An Epstein-Barr viral infection treated with amoxicillin, for example, causes a fine, red rash.

Some believe a family history of reactions to penicillin means they cannot take them. But there is no evidence penicillin allergy is inherited.

If some time has passed between exposure, people can lose the allergic response. This is typically seen in adults who had a mild allergy as a child, but lose the response with time, so are said to have "grown out" of their allergy.

Then there are people who have had a genuine and serious reaction to penicillin. This includes anaphylaxis, with profound swelling, breathing difficulties and low blood pressure, and severe life-threatening reactions such as Steven-Johnson's syndrome, which causes widespread blisters and wounds that resemble burns.

Testing for penicillin

When someone says they have a penicillin allergy, we first get them to explain what happened with the reaction, including to what antibiotic, in what context and how severe it was.

Then we perform skin tests to further assess the person's risk of reaction. If skin tests are negative, we can then give the patient the penicillin in question under supervision (a "challenge") to see if they react.

Some people can skip the skin tests altogether and go straight to the challenge if the history tells us they are at low risk of reacting.

Our study followed 195 patients who reported a penicillin allergy across six Sydney hospitals. In the first phase, we assessed 85 people and found 82% weren't allergic to penicillin.

In the second phase, we assessed 110 people, of whom 69% weren't allergic. This is slightly lower than research on the population as a whole, because we only looked at people who were referred for an allergy assessment. Many more patients carry an allergy label than those referred for testing.

In our study, eight weeks after their test, just 54% of participants in phase one correctly knew their penicillin allergy status. Some allergic people believed they were not allergic, and many non-allergic people believed they were allergic.

For phase two, we ensured people received a standardized letter outlining their results in addition to having a doctor or nurse explain them. This time, 92% were correct in their understanding when contacted eight weeks later.

Reducing long waits for allergy tests

Ruling out allergies among people who think they can't have penicillin is time- and labor-intensive. The wait time from someone first being referred to an allergy clinic to having testing can be up to two years. And it's usually not available outside major metropolitan hospitals.

We need to improve access to testing and also look at 'when' people can access allergy services. When a person is sick in hospital with a serious infection, it's not the right time for testing.

We also need to ensure the results of allergy tests translate to the real world so people know their true allergy status. The fragmentation of our medical records are a barrier to clear and effective communication of a patient's true allergy status, and urgently need to be improved.

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So What’s in Space Right Now?

AN EVEN MORE INTERNATIONAL SPACE STATION When China launched the last stage of its space station in October 2022, it opened up low orbit for scientists far beyond its borders. Tiangong has so far agreed to host projects from 12 countries. In May, the first experimental equipment reached the 54-foot-long station.

A NEW MOON BUGGY In August, with the success of the Chandrayaan-3 mission, India became the fourth country to safely land on the moon (following the Soviet Union, the United States and China). The six-wheeled rover, Pragyan, explored near the lunar south pole, where scientists think deep craters may hold ice.

COOPERATIVE COMMUNICATIONS SATELLITES More than 80 countries have sent satellites into orbit, including many smaller nations, which often share costs and expertise. TurkmenAlem52°E/MonacoSAT, a communications satellite built in France and launched from Cape Canaveral, Fla., is shared by Monaco and Turkmenistan.

EYES IN THE SKY Imagery from satellite constellations from the space-intelligence company Maxar has contributed to several Pulitzer Prizes for reporting. Photos taken by its satellites are used for geospatial intelligence by the U.S. government.

ELON MUSK’S EVER-MULTIPLYING SATELLITES Over 50 percent of all active satellites — currently about 5,000 — are from the Elon Musk-owned company Starlink. Musk plans to eventually have as many as 42,000 of the communications satellites in orbit, as The Times reported this July.

LOTS AND LOTS OF JUNK In 2009, a dead Russian satellite, Cosmos 2251, crashed into an operational telecommunications satellite, creating . . .

CLOUDS OF DEBRIS According to NASA, there are 28,000 pieces of debris in low Earth orbit that are larger than a softball, half a million pieces roughly the size of a marble and 100 million about the size of a pea. Even paint flecks can damage satellites, space stations or spacecraft when traveling at 17,500 miles per hour.

AUTONOMOUS MINERS In April 2021, the China-based company Origin Space launched NEO-01, its first robot designed to test asteroid-mining capabilities. In April 2023, the start-up AstroForge launched a satellite and is now assessing its ability to vaporize and sort an asteroidlike material in orbit.

SCIENTISTS AND THEIR EXPERIMENTS The International Space Station houses astronauts, yes, but we’re not the only living things sent into orbit. Scientists on the station completed around 500 experiments from September 2022 to September 2023.

They have recently worked with 120 Hawaiian bobtail squid to understand how bacteria interact with their hosts during spaceflight.

And they have grown Red Robin dwarf tomatoes to help develop agricultural methods for long space flights.

There’s also a nonhuman member of the current space-station crew: Sasha, a stuffed-animal three-toed sloth, brought as a zero-g indicator; when Sasha started to float in the cabin, the astronauts knew they were entering orbit.

LOGOS, LOGOS, LOGOS If you looked closely at the Ispace lander as it headed for the moon on April 25, you might have recognized some shapes emblazoned on its side: the Suzuki “S”; the crane of Japan Airlines; the rhombuses of SMBC, a Japanese bank. The age of space advertising is here.

WORKS OF ART, BOTH HUGE AND EXTREMELY TINY Art in space ranges from the minuscule to the size of spacecraft. In 2018, the aerospace manufacturer Rocket Lab sent a reflective geodesic sphere called “Humanity Star” into orbit; viewers could see the shining disco ball from Earth.

Works from a second grader and a fourth grader in Florida will soon head into orbit as winners of the state’s Space Art Contest.

In December, the Lunar Codex, a collection featuring works from over 30,000 artists, will launch its first set of more than 5,000 prints, songs, stories, poems and films to the Sinus Viscositatis region of the moon via an Astrobotic mission lander. The artwork is digitized and miniaturized into tiny images, which are imprinted onto a piece of nickel-based nanofiche the size of a dime.

DRUG LABS Commercial drug manufacturing is often easier in microgravity, because protein crystals grown in space tend to form more uniform structures than those grown on Earth. This year, Bristol Myers Squibb led an experiment on the I.S.S. to crystallize medications. The start-up Varda Space Industries launched its first spacecraft in June to test crystal production of ritonavir, an antiviral H.I.V. drug.

ROBOTIC SPACE PLANES The United States and China currently have reusable robotic spacecraft regularly in orbit: two X-37Bs, built by Boeing and operated by the U.S. Space Force; and a vehicle believed to be operated by the Chinese Ministry of National Defense. Combined, the two X-37B craft have flown six times in space since 2010, most recently landing after 908 days in November 2022.

TELESCOPES NOT CALLED WEBB OR HUBBLE There are several telescopes in Earth orbit answering urgent questions about the universe. The IXPE, or Imaging X-ray Polarimetry Explorer, observes some of the most extreme objects in our universe (like supernova explosions and jet streams shot from black holes) to learn how they work.

Charley Locke is a writer who often covers youth and elders. She last wrote for the magazine about pandemic funding and public education. Sean Dong is a motion and 3-D designer in Baltimore. His work often condenses stories of intricate subjects into brief, looping animations.

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Before that, patients would die of relatively trivial infections that became more serious. Some serious infections, such as those involving the heart valves, were inevitably fatal.

Other serious infections, such as tuberculosis, weren't always fatal. Up to a half of people died within a year with the most severe forms, but some people recovered without treatment and the remainder had ongoing chronic infection that slowly ate away at the body over many years.

Once we had antibiotics, the outcomes for these infections were much better.

Life (and death) before antibiotics

You've probably heard of Alexander Fleming's accidental discovery of penicillin, when fungal spores landed on a plate with bacteria left over a long weekend in 1928.

But the first patient to receive penicillin was an instructive example of the impact of treatment. In 1941, Constable Albert Alexander had a scratch on his face that had become infected.

He was hospitalized but despite various treatments, the infection progressed to involve his head. This required removing one of his eyes.

Howard Florey, the Australian pharmacologist then working in Oxford, was concerned penicillin could be toxic in humans. Therefore, he felt it was only ethical to give this new drug to a patient in a desperate condition.

Constable Alexander was given the available dose of penicillin. Within the first day, his condition had started to improve.

But back then, penicillin was difficult to produce. One way of extending the limited supply was to "recycle" penicillin that was excreted in the patient's urine. Despite this, supplies ran out by the fifth day of Alexander's treatment.

Without further treatment, the infection again took hold. Constable Alexander eventually died a month later.

We now face a world where we are potentially running out of antibiotics—not because of difficulties manufacturing them, but because they're losing their effectiveness.

What do we use antibiotics for?

We currently use antibiotics in humans and animals for a variety of reasons. Antibiotics reduce the duration of illness and the chance of death from infection. They also prevent infections in people who are at high risk, such as patients undergoing surgery and those with weakened immune systems.

But antibiotics aren't always used appropriately. Studies consistently show a dose or two will adequately prevent infections after surgery, but antibiotics are often continued for several days unnecessarily. And sometimes we use the wrong type of antibiotic.

Surveys have found 22% of antimicrobial use in hospitals is inappropriate.

In some situations, this is understandable. Infections in different body sites are usually due to different types of bacteria. When the diagnosis isn't certain, we often err on the side of caution by giving broad spectrum antibiotics to make sure we have active treatments for all possible infections, until further information becomes available.

In other situations, there is a degree of inertia. If the patient is improving, doctors tend to simply continue the same treatment, rather than change to more appropriate choice.

In general practice, the issue of diagnostic uncertainty and therapeutic inertia are often magnified. Patients who recover after starting antibiotics don't usually require tests or come back for review, so there is no easy way of knowing if the antibiotic was actually required.

Antibiotic prescribing can be more complex again if patients are expecting "a pill for every ill." While doctors are generally good at educating patients when antibiotics are not likely to work (for example, for viral infections), without confirmatory tests there can always be a lingering doubt in the minds of both doctors and patients. Or sometimes the patient goes elsewhere to find a prescription.

For other infections, resistance can develop if treatments aren't given for long enough. This is particularly the case for tuberculosis, caused by a slow growing bacterium that requires a particularly long course of antibiotics to cure.

As in humans, antibiotics are also used to prevent and treat infections in animals. However, a proportion of antibiotics are used for growth promotion. In Australia, an estimated 60% of antibiotics were used in animals between 2005–2010, despite growth-promotion being phased out.

Why is overuse a problem?

Bacteria become resistant to the effect of antibiotics through natural selection—those that survive exposure to antibiotics are the strains that have a mechanism to evade their effects.

For example, antibiotics are sometimes given to prevent recurrent urinary tract infections, but a consequence, any infection that does develop tends to be with resistant bacteria.

When resistance to the commonly used first-line antibiotics occurs, we often need to reach deeper into the bag to find other effective treatments.

Some of these last-line antibiotics are those that had been superseded because they had serious side effects or couldn't be given conveniently as tablets.

New drugs for some bacteria have been developed, but many are much more expensive than older ones.

Treating antibiotics as a valuable resource

The concept of antibiotics as a valuable resource has led to the concept of "antimicrobial stewardship," with programs to promote the responsible use of antibiotics. It's a similar concept to environmental stewardship to prevent climate change and environmental degradation.

Antibiotics are a rare class of medication where treatment of one patient can potentially affect the outcome of other patients, through the transmission of antibiotic resistant bacteria. Therefore, like efforts to combat climate change, antibiotic stewardship relies on changing individual actions to benefit the broader community.

Like climate change, antibiotic resistance is a complex problem when seen in a broader context. Studies have linked resistance to the values and priorities of governments such as corruption and infrastructure, including the availability of electricity and public services. This highlights that there are broader "causes of the causes," such as public spending on sanitation and health care.

Other studies have suggested individuals need to be considered within the broader social and institutional influences on prescribing behavior. Like all human behavior, antibiotic prescribing is complicated, and factors like what doctors feel is "normal" prescribing, whether junior staff feel they can challenge senior doctors, and even their political views may be important.

There are also issues with the economic model for developing new antibiotics. When a new antibiotic is first approved for use, the first reaction for prescribers is not to use it, whether to ensure it retains its effectiveness or because it is often very expensive.

However, this doesn't really encourage the development of new antibiotics, particularly when pharma research and development budgets can easily be diverted to developing drugs for conditions patients take for years, rather than a few days.

The slow moving pandemic of resistance

"If we fail to act, we are looking at an almost unthinkable scenario where antibiotics no longer work and we are cast back into the dark ages of medicine"—David Cameron, former UK Prime Minister

Antibiotic resistance is already a problem. Almost all infectious diseases physicians have had the dreaded call about patients with infections that were essentially untreatable, or where they had to scramble to find supplies of long-forgotten last-line antibiotics.

There are already hospitals in some parts of the world that have had to carefully consider whether it's still viable to treat cancers, because of the high risk of infections with antibiotic-resistant bacteria.

A global study estimated that in 2019, almost 5 million deaths occurred with an infection involving antibiotic-resistant bacteria. Some 1.3 million would not have occurred if the bacteria were not resistant.

The UK's 2014 O'Neill report predicted deaths from antimicrobial resistance could rise to 10 million deaths each year, and cost 2%–3.5% of global GDP, by 2050 based on trends at that time.

What can we do about it?

There is a lot we can do to prevent antibiotic resistance. We can:

• raise awareness that many infections will get better by themselves, and don't necessarily need antibiotics

• use the antibiotics we have more appropriately and for as short a time as possible, supported by co-ordinated clinical and public policy, and national oversight

• monitor for infections due to resistant bacterial to inform control policies

• reduce the inappropriate use of antibiotics in animals, such as growth promotion

• reduce cross-transmission of resistant organisms in hospitals and in the community

• prevent infections by other means, such as clean water, sanitation, hygiene and vaccines

• continue developing new antibiotics and alternatives to antibiotics and ensure the right incentives are in place to encourage a continuous pipeline of new drugs.

Provided by The Conversation 

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TWIN FALLS, Idaho (KMVT/KSVT) — As we approach the end of the year with the days getting shorter and the temperatures getting colder depression becomes a bigger issue for many.

Dr. Luke Sugden told KMVT pain and depression are directly related as they are both experienced in the same part of the brain.

He said someone who has a lot of physical pain is more likely to be depressed and someone experiencing depression is more likely to experience a worsening of their pain.

Because sunlight and vitamin D are directly linked to mood the lack of daylight can lead to more severe depression and pain which is why Sugden said it’s important to be proactive.

“Make sure you’re getting some exercise and be around people that help improve your mood and work on being in the sunshine and using a sun light, even if those aren’t directly related to your muscle aches and pains improving your mood can help your pain from that standpoint,” said Dugden.

He said taking a vitamin D supplement a few times a week is safe and reasonable and if you feel your depression and pain are worsening to talk with your doctor about having your levels checked.

Copyright 2023 KMVT. All rights reserved.

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One Medical’s value proposition is simple: In exchange for membership dues, which come on top of normal insurance charges for services, customers receive better care, including same-day appointments in two dozen metro areas. That’s proved popular, attracting 836,000 subscribers by the end of last year. Snag is, primary care tends to be a recipe for burning cash. The company, which Amazon purchased for $3.5 billion, incinerated $286 million in 2022, according to LSEG data.

Amazon’s move could be a simple matter of trying to lower prices, grow quickly, and enjoy the benefits of scale. Just look at Amazon Web Services, a business with about $90 billion of revenue annually and 30% operating margins. Digital products, however, have low marginal costs, meaning that selling to an additional customer can easily juice more profit out of an investment. Primary care runs on a lot of skilled labor. Adding customers tends to mean you need more doctors, or quality suffers. Even stripping out sales and marketing, complex administrative costs, and depreciation and amortization, One Medical’s heavily adjusted margin on providing care came in at only 18% of 2022 revenue. Cutting down membership fees, which represented 10% of revenue, could narrow that dramatically if costs grow in line with new customers.

There may be other benefits to Amazon. Drugstore chains have been buying up primary care companies in the hope of steering patients to their stores. Perhaps Amazon can do the same online. But success is not guaranteed. Walgreens Boots Alliance (WBA.O) reported a $566 million adjusted operating loss in its U.S. healthcare division for the 12 months ending in August.

Or perhaps offering better medical care helps Amazon hold on to its most valuable customers. After all, that’s the point of Prime, which had over 200 million members as of 2021. In exchange for a membership fee, customers get free and faster shipping of goods. That leads to bigger and more orders. Amazon has tacked on extra services over time, like video streaming, to make Prime more appealing.

Again, though, others have tried jumping into an unrelated business to aid subscriber retention. Telecom company AT&T’s experience(T.N) with buying media giant Time Warner suggests that realizing a meaningful benefit is hard. The businesses may be so disparate that managers end up destroying value. Cutting membership fees may just make Amazon’s healthcare experiment a bit more costly for itself.

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